SB 174/HB 169 – State Health Plan Data Transparency

Primary Senate Sponsors: Sen. Joyce Krawiec (R-Davie, Forsyth); Sen. Jim Burgin (R-Harnett, Johnston, Lee); Sen. Jim Perry (R-Lenoir, Wayne)

Primary House Sponsors: Rep. Edward Goodwin (R-Bertie, Camden, Chowan, Perquimans, Tyrrell, Washington); Rep. Larry Potts (R-Davidson); Rep. Terence Everitt (D-Wake); Rep. Allison Dahle (D-Wake)


This bill makes a series of amendments to provisions governing the State Health Plan for Teachers and State Employees including the following:

  • Revises definition of “Claims Payment Data” to include the rate negotiated with or agreed to by the provider.
  • Requires the Claims Processor to disclose the Claims Payment Data on a member level for claims paid with State funds.
  • Exempts Claims Payment Data from public record.
  • Removes language prohibiting the Plan from using Claim Payment Data to negotiate rates, fee schedules, or other master charges with providers.
  • Permits the Plan to disclose Claim Payment Data to a third party to use on the Plan’s behalf if the Plan provides notice to the Claims Processor.


SB 174

Filed 3/2/2021

HB 169

Filed – 2/25/2021

This bill was referred to the following House committees:

-State Government

-Pensions and Retirement

-Rules Calendar and Operations